In 2008, CareNet, Inc. received a grant from The Duke Endowment to “develop and implement a counseling and professional services program for clergy and congregations to address issues that impact mental health.” From that initial grant support, CareNet now provides wellness opportunities, education, and counseling services to clergy and congregations across the state of North Carolina. During the next 12 months, we will provide approximately 40,000 hours of counseling services to people of faith in our state. We have developed formal and cooperative relationships as faith-integrated behavioral health providers with 5 denominations and countless local congregations across the state.

CareNet is also embedded in the Division of FaithHealth at Wake Forest Baptist Medical Center and actively connects congregations to the medical center and local hospitals to improve the health of congregants and communities.

This resource is one of the results of our collaborations with The Duke Endowment and FaithHealth. It is our third edition of Congregational Mental Health Literacy and is designed to provide clergy and congregational leaders with resources to use in worship/preaching, education, spiritual practices, and pastoral care in and through congregations.

The foundational scripture, 2 Timothy 1:7, used by our writers for this version align with our Million Acts of Kindness campaign, which began with a large community rally last fall and has been continued through the Winston-Salem/Forsyth County Schools as a way to reduce incidents of bullying among youth and children in our community.

We invite you to read the resources, find creative ways to utilize them in your congregations and communicate with us about the conversations that are created. You can email us through carenet@wakehealth.edu.

In 2008, CareNet, Inc. received a grant from The Duke Endowment to “develop and implement a counseling and professional services program for clergy and congregations to address issues that impact mental health.” From that initial grant support, CareNet now provides wellness opportunities, education, and counseling services to clergy and congregations across the state of North Carolina. During the next 12 months, we will provide approximately 40,000 hours of counseling services to people of faith in our state. We have developed formal and cooperative relationships as faith-integrated behavioral health providers with 5 denominations and countless local congregations across the state.

CareNet is also embedded in the Division of FaithHealth at Wake Forest Baptist Medical Center and actively connects congregations to the medical center and local hospitals to improve the health of congregants and communities.

This resource is one of the results of our collaborations with The Duke Endowment and FaithHealth. It is our third edition of Congregational Mental Health Literacy and is designed to provide clergy and congregational leaders with resources to use in worship/preaching, education, spiritual practices, and pastoral care in and through congregations.

The foundational scripture, 2 Timothy 1:7, used by our writers for this version align with our Million Acts of Kindness campaign, which began with a large community rally last fall and has been continued through the Winston-Salem/Forsyth County Schools as a way to reduce incidents of bullying among youth and children in our community.

We invite you to read the resources, find creative ways to utilize them in your congregations and communicate with us about the conversations that are created. You can email us through carenet@wakehealth.edu.

Rosa Miranda is the organizing pastor at El Buen Pastor, Iglesia Presbiteriana in Winston-Salem, North Carolina.

“God did not give us a spirit of cowardice, but rather a spirit of power and of love and of self-discipline.” 2 Timothy 1:7

Educational Resource by Lori Walke

2 Timothy 1:7 “God did not give us a spirit of cowardice, but rather a spirit of power and of love and of self-discipline.”

The author of the second letter to Timothy and his community was very focused on building up and encouraging those who read the letter. He wanted to remind them that they were loved and appreciated. In the verses just before our passage, he notes their sincerity and faithfulness. But the author knows that something isn’t quite right in Timothy’s community. When we read between the lines, we see that this early church was struggling with, among other things, self-doubt.

Take time to reflect individually or to discuss as a group the following questions:

Think of a time when you felt alone in the midst of doubt or just discouraged.

What is it like to be in that situation with no one else with you?

Many times in our own lives we need others to remind us not only that we have gifts and strengths that help others, but also that we are simply appreciated.

Take time to reflect individually or to discuss as a group the following:

Make a list of the times you were encouraged by someone else.

In what form did their encouragement take shape? Through a letter, face-to-face, an email?

How did their encouragement make a difference to you?

The passage reminds us of the great need we have for each other as human beings. Even if we are not struggling with self-doubt, depression, etc., a simple word of appreciation can make a big difference. We need others to remind us of our own gifts and value. The author of this passage expresses how the community has encouraged him and is returning the favor. In turn, we are reminded of our responsibility to do to do the same for people who make a difference in our lives.

Take time to reflect individually or to discuss as a group the following questions:

How do you show appreciation for others and remind them of their gifts and strengths?

Reflect on the people who make a difference in your life, no matter how great or small. Your family? The janitor at work? The person behind the counter at the grocery store/drycleaners/restaurant?

Make a list of ways you can encourage these people or communicate appreciation for them.

Pastoral Care by Samuel Stevenson

2 Timothy 1:7 “For God did not give us a spirit of cowardice, but rather a spirit of power and of love and of self-discipline.” (NRSV)

Early in my ministry, an older minister, whom I had never met, sat quietly as other members of his committee examined me on my readiness to practice pastoral ministry in their presbytery. As the committee was approaching closure, the older minister broke silence and, with a deeply penetrating gaze, said to me, “Young man, I don’t know what kind of Christian you are, but those trousers you have on, you may as well go and buy a new pair because you’re going to wear those out on your knees.” Then he burst into great laughter. I found myself laughing nearly as heartily with him. Then everybody began laughing, seemingly confirming the wisdom of the moment that reminded us of our common dependence upon God’s grace. I came before the committee full of fear and trembling, but the older minister’s statement and approving laugh made me feel like his son. I was enormously encouraged.

Paul is that older minister for Timothy. Paul refers to Timothy as his own dear son, his beloved child. Paul was Timothy’s mentor and role model. There is a genuine sense of inseparable togetherness. One can feel the depth of membership that each has in the other. Paul is the seasoned father figure in Christ. He knows the doubts and fears that cling so closely. He knows the road to life is hard and narrow. He knows that mortals forget the power inherent in their spiritual roots and need to be reminded of the gift within them. He knows that cowardice can hold sway when one forgets that the work is the Lord’s. For God did not give us a spirit of cowardice, but rather a spirit of power and of love and of self-discipline.

What Paul does in his pastoral ministry to Timothy is useful for ministering to people with a variety of human problems, including victims of bullying.

We can take time with people and get to know them in a more personal way, that with better understanding our practice of pastoral ministry may have greater meaning and relevancy.

We can show a concern for the hurting in our prayers, worship, fellowship, and community partnerships.

We can build on family strengths by calling upon the spiritual resources of ancestors to remind those who are hurting that they are descendants of a great crowd of witnesses in Christ, and that they are God’s children too.

We can be mentors and role models to those who may be abandoned, rejected, and bullied, identifying with them and assuring them that somebody genuinely cares and will walk with them along life’s treacherous paths.

We can ask the Holy Spirit to help us keep the hurting constantly in our prayers so that all of our pastoral ministry will be by the leading of the Holy Spirit.

Spiritual Practice by Jane Litzinger

2 Timothy 1:6-7 “For this reason I remind you to rekindle the gift of God that is within you through the laying on of my hands; for God did not give us a spirit of cowardice, but rather a spirit of power and of love and of self discipline.” (NRSV)

“Wake Up…”

We are the receivers of a wonderful gift. St. Paul’s letters abound with images of the gift of God’s saving love that has been given to us in the mystery of Christ. I never tire of recalling these words about our giftedness from John Shea, a favorite teacher for me about things spiritual. He says:

Although the spiritual is always present, people are not aware of it. If we think of this in terms of images, we can say we have a vintage wine cellar, and we rarely drink from it. We have an interior castle, and we seldom visit it. There is a treasure buried in our field, and we do not know how to unearth it. (See, Spirituality and Health, pp.94-95)

For Shea, our spiritual “problem” is that we live unaware of the wonderful gift of love that God has given to us. He uses familiar biblical images to explain our problem further: we are asleep, and we need to awake; we are blind, and we need to see; we are deaf, and we need to hear.

The author of our current text reminds Timothy (2 Timothy 1:6) to rekindle the gift of God that is already within him. This gift of God’s love brings a spirit of power and of love and of self-discipline. Timothy is challenged to remember this great gift of God within and relying on that gift to be finished with cowardice and timidity.

The purpose of all spiritual practice is to help us wake up to God’s gift already given to us. Simply, we practice paying attention to God’s gift of love already within us. In the last year or so, a practice that has helped me to wake up, to pay attention, indeed to rekindle the gift of God’s love within goes something like this. I say Psalm 23 very slowly, paying attention to each phrase, letting it be not a quick recitation to get through but a real declaration of the truth of God’s love and God’s way with me. Now and then I visit Psalm 23 (or better Psalm 23 visits me) as I do laps at the gym or as I go to sleep or as I wake up in the morning. I encourage you to choose some psalm or prayer that you love and slow down as you pray it, pay attention, let it be a place where you can rest your heart and your mind, where you can find a moment of faith and hope in a too busy day.

Bishop Desmond Tutu has this wonderful idea that remembering God’s gift of love within enables us to become what he calls a “center of love,” an “oasis of peace,” “a pool of serenity” with ripples going out to God’s other loves, the brothers and sisters that are part of our lives. Listen to his words as he instructs us in those spiritual practices that help us wake up to ways we pass on the love God has given within us. Note that I took the liberty of underlining the spiritual practices that he suggests. I hope that his very concrete ideas will be a starting place for you as you wake up to the ways you are called to love those you engage in everyday living.

If more of us could serve as centers of love and oases of peace, we might just be able to turn around a great deal of the conflict, the hatred, the jealousies, and the violence. This is a way that we can take on the suffering and transform it. Let us watch our tongues. We can so easily hurt one another. Our harsh words can extinguish a weak, flickering light. It is far too easy to discourage, all to easy to criticize, to complain, to rebuke. Let us try instead to see even a small amount of good in a person and concentrate on that.Let us be quicker to praise than to find fault. Let us be quicker to thank others than to complain. Let us be gentle with all God’s children. (See, God Has A Dream, p.80)

Preaching Resource by Rosa Miranda

2 Timothy 1:7 “For God has not given us a spirit of fear, but of power and of love and of a sound mind.” RVR 95

“For the Spirit God gave us is not of fear but of power, love and self-control.” Pilgrim’s Bible

“Because we the Lord gave us a spirit not of timidity, but of power and love and self-control.” Jerusalem Bible

Throughout the Bible we see that at the end of their lives, many leaders leave a legacy of final instructions. And in the Epistles to Timothy, the apostle Paul from prison in Rome (or someone writing in his name) directs final words of encouragement and challenge about the complex situation “his beloved son Timothy” will face; and with him, men and women of his time, followers of Jesus Christ.

And although it is clear that the situation faced by Timothy in his ministry is different from the issue of bullying faced by our young people today, both situations have in common that they require certain values ​​for personal and community life, as well as the construction of one’s own resources to face adversity and injustice that inevitably will be part of life experience. (2:22)

And this exercise is done in the pastoral epistles to contextualize the teachings of Jesus to the reality of life in the community of faith, so that they bear meaning and relevance in the lives of believers in their own time and circumstances; we have done the same for young men and women faced with the reality of being young and a disciple of Jesus Christ here and now, in times of globalization and post modernity.

Because it takes the courage that comes from commitment to the living Savior to accept the tension between faith and daily life, to have the strength not to give in to peer pressure, to leave behind the fear of not belonging or being isolated, while choosing to be a positive influence.

Timothy had the influence and example of people who left positive imprints in the early years of his life, like his grandmother Lois and his mother Eunice. (3:14-15) And this brings us to the subject of the family – a concept very diverse and complex, but still the core where human beings learn and internalize their values, and their faith, ​​through their experiences. (Deut. 6:4 to 9) It’s important to note that values ​​are observed and mimicked, and this is how we learn. What is our influence as parents? How do we prepare our kids for life?

In the Sermon on the Mount, Jesus teaches us the values of the Kingdom. Each of them involves responsibility and initiative and the realization that our actions have consequences, such as: “Do unto others as you would have them do unto you.” (Matt. 7:12)

The Kingdom values he teaches​​- justice, equality, dignity, solidarity and inclusion, among others – calls us to be a community of faith that is a safe and welcoming space in which it is possible to recognize and acknowledge the other as a person of value and dignity in Christ Jesus, with responsibility and respect.

He calls us to be a community of belonging in which it is possible to dialogue and discover that everyone can be part of the solution, to learn to listen and observe, to empathize but also, when necessary, to confront and resolve conflicts with wisdom, love and self-control that the Holy Spirit gives us. (2:25)

Self-control is possible from youth, through identity in Jesus Christ. (1 Tim. 4: 12; 2 Tim 2:22) One is learning to be an example – not a perfect one – but growing and building toward a full life – without bending, honestly before God and one’s faith community. A mistake is an opportunity to learn and grow. What is our influence as a faith community? How do we support the participation of youth in the work for justice?

We do not like to talk about adversity and suffering – but even though we don’t, both take place in our lives. We are sent by Jesus Christ to the world with the truth of His Word and His protection (John 17: 13 to 19). In his own context, Timothy is again and again alerted and challenged to focus his faith and hope in Christ Jesus in times of suffering, while being encouraged to choose and fight his battles wisely (2:15 -17; 3: 1 to 5). Following the parallel, let’s open spaces at home and in the community of faith to raise awareness of what harassment (bullying) is and to explore how we can confront together. Let’s affirm that it is unacceptable and share resources to learn to “fight the battles with wisdom and trust” if the situation arises.

Finally, Paul had Timothy, his ministry partner, but also a mentor and maybe even a father figure who had great influence in his life. He was someone Timothy respected and trusted. He was someone who in his most vulnerable moments was present with Timothy sharing meaningful experiences to encourage him to continue living in the tension between faith and the reality of his life and ministry. How many of our young men and women need leaders that give them affection and trust, who will listen and pray for them? How are we preparing our leaders to identify and address bullying behaviors?

Our current vice president, Gary Gunderson, was previously employed by the Carter Center, a nongovernmental organization helping to improve life for people in more than 70 countries by resolving conflicts; advancing democracy and human rights; preventing diseases; and improving mental health care. While at the Carter Center, Dr. Gunderson spearheaded many of their relationships with the intersection of faith and health.

CareNet is now building on and developing a further relationship with the Carter Center. They will serve in consultant capacity to help us in two primary ways. First, we will expand integrated behavioral health in primary care facilities across North Carolina. Second, using a current program called SBIRT (Screening, Brief Intervention, and Referral to Treatment), an early assessment of drug/alcohol usage in a primary care setting, we’re going to adapt it to congregational settings or faith contexts. We believe we can train people to do these assessments in faith contexts and use that adaptive logic to move it out of the primary care clinic and into congregations.

What we know is that if we can do early detection of drug/alcohol usage, it will lesson the likelihood that it will turn into chronic diseases, which is an epidemic in our country and costing our health care system. We think the relationships that clergy have, particularly in congregations where there might be heavy Medicaid members and in African-American congregations where they get a lot of actual health information and support, are vital. Therefore, we’re depending upon and raising the profile of faith communities as deliverers of prevention and wellness health care.

There is a significant health impact of congregations on their congregants and community. Good preaching, good pastoral care, good Bible study, good follow-up, these all increase health in a community. Church has just never thought of itself in this way. Research shows that a healthy church decreases what we call social determinants that eventually lead to good health. Churches that are healthy, that really take seriously their call, have been doing this for a long time. But they’ve never quite seen the connection between what they are doing and health care. We plan to change that.

It will be held Saturday, October 12 at the Winston-Salem Dash BB&T baseball park.

They will again have the all-community walk against bullying and then have a program that focuses on ways to help kids and adults understand how to reduce the incidences of bullying as well as education and workshops to help children of different age groups deal with bullying.

A new concept will be discussed: “verbal judo,” or verbal self-defense, which teaches children how to stand up for themselves to stop bullying. Verbal Judo has been taught to police officers over the years to help deescalate violent people.

“As a mom, I was not very good at these things when my children were little. I remember telling my kids, if you get bullied, just ignore them or turn the other cheek, which seemed like the right thing to do. But it’s really not the best thing to stop or prevent bullying because you can be perceived as weak and you may even end up being bullied more. Standing up for yourself with a strong stance both physically and verbally can be very effective if you are taught how to do it correctly.”

Barbara Saulpaugh, CareNet Counseling regional director

The schools and community have really embraced this project. Along with CareNet Counseling, they all hope these annual events will help educate others on how to stop bullying. Watch for more information at www.wsfcs.k12.nc.us.

Through the Harnett County CareNet center, we have had two meetings targeted to the faith community to ascertain the feasibility of starting a center in Fuquay-Varina that would also serve the Raleigh suburbs.

Through the kindness and support of the Raleigh Baptist Association, we have housed a CareNet center in that area for the past year. We will transition from that site to a location right off the main street in Fuquay-Varina that has been provided through the generosity of a well-known Baptist layman, Bob Barker, CEO of Bob Barker Enterprises.

We plan to have two full-time staff members in this new location opening by August. This location will be an extension of our center in Harnett County with the business office remaining in Erwin. The local faith community has been very supportive.

United Community Ministries (UCM) was founded in 1977. It is a non-profit organization composed of local religious, governmental and private supporters who are committed to addressing the needs of the homeless and nearly homeless populations in Nash and Edgecombe Counties in Eastern NC. Located in Rocky Mount, UCM is the only emergency shelter and transitional housing for the general homeless population in the area. They served over 340 homeless individuals last year. UCM provides emergency shelter and also feeds an average of 30,000 meals annually through its soup kitchen.

UCM’s three-fold components start with the McDonald Street Shelter. This is the place where homeless, single adults, both male and female, can find housing. Many of them are there because of poor life choices, some because of addictive behavior. Many times these individuals have no other resources – either they’re cut off from family or because of no money, they can’t afford or do any differently.

At the shelter, the inhabitants are constantly attending group therapy and training. The staff is trying to help elevate the skill level of the persons involved. After they have been at the shelter for a period of time to establish themselves, learn the rules and accomplish a certain number of points (through their point system), then they can begin on-campus or on-site jobs. Once they’ve proved themselves worthy, they can have jobs off site. The residents set multiple goals; among them are being able to maintain some type of job, working toward reconciliation with family or getting themselves to a healthier place so that they don’t go back and repeat the cycles that exist. They often come from many non-functional patterns of behavior that the staff of UCM and the CareNet Counseling East’s clinician, David Winstead, a second-year Master’s-level student at East Carolina University (Marriage and Family Therapy program), helps to change.

“The staff tell uplifting stories about several situations where one member of a family had come, received the skills that they needed and gotten their ‘life on track.’ Then they would send the next member of the family to receive services.

They have success rates in some individuals who had gone from a place of joblessness and homelessness to where they are now managing restaurants and hotels and becoming not only healthy individuals but also giving back to the community.

I think, honestly, it is one of those aspects of the work we do that isn’t often heard about but is so very rewarding.”

Janie Taylor, Interim Coordinator of Clinical Services, CareNet, Inc

In 2001, UCM opened the Bassett Center to help meet the ever-present need of housing for families with children who are at-risk for homelessness. Records indicate that more than 600 children have been identified as homeless within the Nash-Rocky Mount School system. Bassett is said to have an average of 45 families on its waiting list for housing at all times.

For the past year, CareNet Counseling East has worked with the personnel at the McDonald Street shelter and Bassett Center to schedule their clinician. They expect to add a second clinician by the end of July so that they will be on-site two days a week and hope that later they may partner with UCM to serve some of the victims of domestic violence through a different and fellow ministry of UCM. None of the individuals who are in the center and are served by CNCE have any type of health insurance. As a result, they are at the mercies of whatever system exists for not only their medical care but also for their psychotherapy needs. The CareNet services are provided at no expense to any of the clients or to the center itself.

The third program that UCM operates is the PHP, Permanent Housing Program, and it is for individuals who have been able to maintain their goals who are moving to a place with independence through this transitional housing.

CareNet Counseling East was able to discover this ministry existed by means of the president of the Rocky Mount Advisory Board, the Rev. Jody Wright, who pastors Lakeside Baptist Church, and the executive director of UCM, Chris Battle, who is also a member of the Rocky Mount Advisory Board. This partnership is a great way for them to serve persons who were underserved and to give back to the community. It’s a very collaborative work between the UCM personnel, some of the medical providers in the area and CareNet Counseling East.

“We have found that every time we reach out to someone, we are enriched as well,” reflects Janie Taylor.

Obesity is about more than extra pounds. It’s a complex medical problem that requires a serious treatment plan. The Weight Management Clinic at Wake Forest Baptist Medical Center, located in Winston Salem, provides patients with real options so they find the best program for their lifestyle and weight loss goals.[1]

Anyone who desires weight loss and would like medical support can find it at the Weight Management Clinic. They currently offer two programs: the By Design Optifast for those who need to lose more than 50 pounds and the By Design Essentials for those interested in losing less than 50 pounds.

The Weight Management Clinic has a psychologist and counselors on staff who specialize in helping people overcome the barriers that stop them from eating well and being active. Their behavioral approach uses counseling in group and individual sessions, and with this support, they help the patients build skills that keep them successful long-term. [2]

CareNet currently provides two counselors to this center: Adrienne Reich, LPC and LCAS, who spends two half days helping clients, and Monica Corbitt Rivers, PhD.

Our counselors primarily focus on two aspects: individual consultations with patients around their behavioral goals in weight management and weight loss and group sessions that involve some psycho-education and group processing. Adrienne Reich is also working on a third component to write curriculum for a new program containing around 25 weight management topics with theory, pointers, tips, etc.

At the Weight Management Center, I help patients gain insight into what they need to do to not only get the weight off but to keep it off long term. Many of the patients have been in weight loss programs before and reached their goal weight but have gained it back as they fall into old patterns of behavior. My job as one of the behaviorist is to help them identify what patterns of behavior they need to break such as eating when they are stressed, bored, lonely, or as a reward after a long day and help them learn what else to do during those time. I also help patients learn how to eat healthy at restaurants as well as how to navigate social situations since food is such a big part of birthdays, holidays, family gatherings, and other celebrations.

CareNet has established a relationship with the Department of Psychiatry at Wake Forest Medical Center to provide academic lectures in spiritually integrated treatment for the psychiatric residents beginning in August. It is part of the psychiatry department’s commitment to exposing the residents to more integrated approaches to psychiatry by teaching them about the importance of spirituality to their patients. CareNet will also begin embedding fourth year psychiatric residents in our CareNet Winston-Salem clinic with an eye to expanding those positions across the state to other CareNet clinics. The long-term hope is that we will have psychiatrists entering into communities who really understand the impact of faith as it relates to treatment.

We will also be connecting our master’s level psychology residents with medical residents in psychiatry. Professionals from different guilds and disciplines, as we try to solve the health care crisis, are entering into conversations realizing that we have more in common than not. We are getting out of our professional silos to benefit the community at large. We see this new relationship as an important step in that direction.

Five residents in CareNet’s Residency in Psychotherapy and Spirituality received certificates and commissioning in a graduation worship service on Thursday, June 20, 2013. Brooke Batts, Nick DeJesus, Carleton Irving, Jaime Reyes, and Robert Willis have completed the three-year training program and will transition to full-time clinical staff at CareNet centers across the state.

Center directors and staff, as well as family and friends of the residents, all gathered in Wake Forest Baptist Medical Center’s Davis Chapel to worship and to celebrate the accomplishments of this special group of residents. During the past three years, these five residents have provided over 7,000 hours of counseling service in their communities and saved their centers nearly $400,000 in client aid funds. All five became licensed by the state of North Carolina, and all are equipped with skills to provide high quality faith-integrated counseling as members of the CareNet team of clinicians.

CareNet President Steve Scoggin said of this group, “This cohort of residents launched their ministries amidst radical changes in healthcare. Behavioral health is no longer on the sidelines of healthcare but is fully a player towards a solution to complex problems and chronic conditions. This group of residents exemplifies the creativity and compassion necessary to thrive in the new world emerging in healthcare. They truly are the best of the next generation of compassionate professionals who will care for our most vulnerable.”

In a sermon addressing the graduates, Residency Director Russell Jones said, “The most important thing you bring to your client is love. It’s not how much you know. It’s not how skillful you are. It’s not whether you’re using an evidence-based therapy intervention. All that is important, but it’s not most important. What’s most important is love. Paul says in 1 Corinthians that our various gifts, our knowledge, even our faith — they’re all powerless without love. The Beatles said, ‘All you need is love.’ The great Sigmund Freud, not exactly the poster-boy of the warm fuzzy, said counseling is ‘a cure through love.’ In all things, even psychotherapy, it is love that matters.“

CareNet understands the importance of integrating our behavioral health care providers into medical offices, such as primary care physicians, family doctors, internal medicine, etc., and working with these doctors who are on the front line of interaction with patients.

Partly driven by the Affordable Care Act, there is a calling for primary care services, which includes behavioral and mental health, to be located together in the same offices, buildings, or suites of offices. We believe that if patients can go to just one parking lot and access their primary care doctor, their therapist, their nutritionist, etc., then they are more likely to use the resources available to them. For those patients who use primary care as the frontline for services, this integration will decrease their need to go to the hospital.

Research shows that 60% of all medical issues that show up in a primary care doctor’s office have a behavioral health care issue to them. Many of them are stress induced, anxiety induced, or associated with depression. Many of our both acute and chronic medical issues can be managed through life-style change. Diabetes is an example – if we can help patients know, not just what to eat, but also integrate a new way of eating, we will be more successful. Even a theology of food can lead to a change in behavior. Putting our counselors in these places where the conversations happen gives the patient more access to more resources.

CareNet is already doing integrated behavioral health care in five locations across the state of North Carolina. The settings are all somewhat different: two are basic family doctors’ offices, one is a pediatric office, one is a medical practice strategically placed in an underserved area of Winston-Salem where most of the patients are on Medicaid or uninsured with difficult transportation issues, and one is in a Weight Management Clinic at Wake Forest Baptist Medical Center.

The counselors are working both within and without the Wake Forest Baptist Health Medical system. The Medical Center owns two of the clinics, one has a connection to Wake Forest Baptist Health through the Maya Angelou Center, which looks at injustices of the health care system, and the other two are connections through the CareNet counselors who had already created relationships themselves with primary care doctors in their community.

The newest co-location is the brand new Weight Management Clinic. Surprisingly, a lot more people have been signing up for the program than they imagined and more of those people are 15-20 lbs overweight rather than those who are morbidly obese. The clinic is already reporting that the two CareNet clinicians in the office have made a huge difference for these patients, and their help is already working. Because the patients are in a pretty good place when they enter the clinic, if they can make a change now, they won’t need more sophisticated services down the line.

In other locations, substance abuse is a big issue, which does not just mean alcohol or street drugs. The therapists are onsite to talk about those kinds of issues, and to catch people who may be on the front end of addiction. If it is caught early, and they can help people reflect on their practices, the patient can make small shifts now that will not become bigger issues down the road. There are also medical conditions related to depression – somatic complaints. We can help the patient see that it is not a stomachache that is the health issue, but, rather, the stress they are living under. Because of integrated behavioral health, the therapists are in place to help patients with mental health.

CareNet does have these five co-locations now; however, there is a need that in the next two years, everywhere there is a CareNet clinic, we will also be integrating behavioral health with a physician in some way. While there are already groups around the country doing this, it is really small scale. No one has developed the skill set to do this really well, and the information is not consolidated in one useful place (textbook, website, etc). As a way to begin doing the work and preparing ourselves to be a real leader for this kind of service in the near future, CareNet has internally developed a learning group with about 15 people from our network.

The structure of the learning group is virtual with the members meeting about every three weeks by web cam. They introduce resources to Bryan Hatcher; he vets and creates a short list. They all read the same articles, and then they review and discuss together. The learning group is defining the skill sets and characteristics necessary for a mental health counselor to do this kind of work. Integrated behavioral health is not for all counselors. It is a different kind of work; they are part of a medical team. They may have only one or two scheduled meetings a day, but they are constantly doing consultations with doctors, joining in medical evaluations. They get to hear the initial conversations from the clients and listen for mental health issues. Then they consult with the doctor and patient to help them get to a better place. These counselors will do brief interventions, not long-term counseling in the doctor’s office. If what the patient needs is long-term counseling, they will refer them to an appropriate provider. The point is to provide good, immediate care in the heat of the moment.

Already, counselors have intervened in about half a dozen cases with patients who were actively suicidal. They connected them to the resources they needed immediately to avert suicide and get help. In a few cases, the therapist helped in the reverse way. The doctor was ready to send the patient to the emergency room for suicidal tendencies, but instead, the therapist helped the doctor and patient communicate more clearly that suicide was not imminent. Integrated behavioral health provides people the help they need to get better quicker and averts the use of system resources when they are not necessary, thus improving the quality of care that our health system uses.

At some point, the learning group will send out teams from this group to locations around the country to other health care systems that are integrating behavioral health and have a good track record. They will not only theoretically but also existentially know what this business is like and how other folks are doing it. CareNet hopes to create a certificate program or integrate into a degree program for formal training around integrated behavioral health. And perhaps most important, CareNet brings something different to this process than most mental health providers – the spiritual-integrated health component.

We want to be experts in integrated behavioral health. The goal would be to become a thought and practice leader in this area with the plans to take what we learn and give it back to the world through formal academic programs, seminars, personal connections, etc. We are actively learning with each other, and we want to tell others around the world that they should be doing this, best practices, and the reasons why.